Brown researchers fear loss of funding under Trump

Sunday

Dec 25, 2016 at 9:50 PMDec 25, 2016 at 9:50 PM

Anxiety over what a Trump administration will mean for public health and the funding that drives its research is one that's shared by many at Brown, from top administrators and department heads to professors, some of whom are speaking out on blogs posted on the university's website.

Lynn Arditi Journal staff writer lynnarditi

PROVIDENCE, R.I. — In anticipation of Donald Trump’s presidency, Thomas Trikalinos has resigned himself to spending a good chunk of his holiday break at the office.

Trikalinos, director of Brown University’s Center for Evidence Synthesis in Health, will be racing to complete twice the usual number of grant applications to keep the center funded. He describes the effort as a “hedge against the eventuality of a bad time.”

By “bad time” he means research funding cuts.

Anxiety over what a Trump administration will mean for public health and the funding that drives its research is one that’s shared by many of his colleagues at Brown, from top administrators and department heads to professors, some of whom are speaking out on blogs posted on the university’s website.

“Part of public health is developing a database through research and that database helps us to inform solid, thoughtful policy decisions,’’ Brown University School of Public Health Dean Terrie Fox Wetle said. “So, I’m worried…”

That concern, she said, is about the future of two important sources of public health research funds: an independent nonprofit created as part of the Affordable Care Act, known as Obamacare, and a federal agency that has previously been targeted by Republican lawmakers.

The nonprofit known by its acronym PCORI (which stands for Patient-Centered Outcomes Research Institute) has awarded $6.2 million over five years to fund five studies in Rhode Island, including four at Brown and one at Women & Infants Hospital. PCORI funds projects that don’t normally make headlines.

Though funded through the Affordable Care Act, the type of research the nonprofit supports has been championed by Gail R. Wilensky, a former senior health and welfare adviser to Republican President George H. W. Bush. The so-called comparative effectiveness research aims to figure out if similar treatments that cost less might provide the same benefits.

“There are a lot of things we don’t know about Trump’s agenda,’’ Dr. Ira B. Wilson, Brown University School of Public Health’s chairman of health services, policy and practice, said. “Everybody is worried that PCORI will be either crippled or killed. ...We have several millions of dollars of research grants which are related to PCORI, so it’s quite significant."

The PCORI Trust Fund is up for re-authorization by Congress in 2019.

Brown’s Center for Evidence Synthesis that Trikalinos heads received about $912,000, or 17 percent of its fiscal 2017 funding, from PCORI. The money pays for research designed to predict how well particular treatments will work in a population different from the ones used in research studies, he said.

A much bigger share of the center's funding — $2.9 million or 55 percent of its research grants in fiscal 2017 — comes from a federal agency known by its acronym AHRQ (pronounced “arc”), the Agency for Healthcare Research and Quality. It has funded the center’s projects in collaboration with the federal Office of Dietary Supplements.

One study reviewed research done on vitamin D to determine who should take it and in what quantities. The agency also has funded the center’s report on omega-3 fatty acids and heart disease that was used to set dietary guidelines. And AHRQ grants have funded research to validate federal recommendations for flu vaccination for frail older adults.

No other agency in the country, including the National Institutes of Health, Trikalinos said, has a program that systematically funds this type of evidence synthesis. “AHRQ is practically the only place,’’ he said, “where people can get money to do the research on how we know what we know.”

Brown’s Dean Fox Wetle urged Rhode Island lawmakers in Washington to preserve the agency. “This research helps Americans get their money’s worth when it comes to health care,’’ she wrote in a June 15, 2015 letter to U.S. Rep. James Langevin. “We need more of it, not less.’’

If Republicans in Congress make another run at AHRQ, Trikalinos and his colleagues may have to look for funding elsewhere.

So, where would academic researchers like him look for funding?

“Right now we do not ask money from industry,’’ Trikalinos said. “We don’t want to be perceived as having a conflict of interest ... But if money dries up [from AHRQ and PCORI] we would have to consider different funding streams.’’